Name: This is the person responsible for cleaning up from event and the safety and security of participants. (*)
Please type your full name.
Email Address of Requester: (*)
Invalid email address.
Phone Number: (*)
Invalid email address.
Location of Event (gym, library, classroom, etc) (*)
Gym Front Door (Mission Ave) Library Classroom Other: Describe below Invalid Input
Other Location Requested:
Date Access Needed: (if period of time, list inclusive dates) (For example, from 12/15/16-3/1/16); please indicate if every week, every other week, once a month, etc. (*)
Days of week needed:For inclusive periods, if you only need one recurring day of week, just click that day of week. (*)
Sunday Monday Tuesday Wednesday Thursday Friday Saturday Invalid Input
Time Access is Needed: Example, if you coach and you need every Tuesday from 4:30pm-5:30pm, you could list (4:30pm-5:30pm). If you need time to set-up, you need to include that in request so maybe you'd prefer 4:15pm-5:30pm). Requester can not leave early if access requested is still open (ex. if you request doors open until 7pm, but your event ends early (ex. 6:30pm), you can not leave until scheduled end time because doors will still be set "open." For this reason, please be conservative in requesting times. (*)
Are you requesting a specific time access or an access card? (*)
Specific Time (no card) Access Card Invalid Input
I have read and understand the Acceptable Use Policy (if requesting badge and/or keys): This paragraph outlines guidelines for use of keys and access cards used for entrance to St. Mary’s School, Bellevue, and any of its associated facilities, such as the Gymnasium, the Extended Day Care Area, and the Dominican Center. The purpose of these guidelines is to ensure that St. Mary’s School key and access card users use these resources in accordance with the best physical security practices to insure the safe operation of the School, particularly in an ethical and lawful manner. Unauthorized use of a St. Mary’s School Building key or access card is a violation of Nebraska and United States law and my constitute theft and is punishable by law. • St. Mary’s School Building key and access cards are to be used only for the purpose for which they are authorized and are not to be used for non-St. Mary’s School related activities. • Users are responsible for protecting issued keys and cards. • Users are required to notify the School office of a loss of a key or card within 1 day of noticing the key or card is missing. • If a key is lost, the User will be charged a $5.00 fee to replace the key. If an access card is lost, the User will be charged a $10.00 fee to replace it. • Users will not make any copies of issued keys or cards without the PRIOR approval of the School Principal. Any noncompliance with these requirements will constitute a security violation and will be reported to the Principal of St. Mary’s School Bellevue and may result in short-term or permanent loss of access to St. Mary’s School and associated facilities. Serious violations may result in revocation of School access, as well as civil or criminal prosecution. I have read and understand the St. Mary’s Bellevue School Key and Access Card Acceptable Use Policy for use of the St. Mary’s School Building keys and access cards, and agree to abide by it. (*)
YES NO Invalid Input
I have read and understand the Guidelines for Facility Use : Below are the guidelines for facility use. Please review and acknowledge by signing that you have read, understand and agree to comply with directives. Thanks. 1. SCHOOL PROPERTY - School property will not be loaned, borrowed, or removed from school premises for this event. School property such as chairs, tables, basketballs, etc. may be used when using the facility under the rules herein. 2. FACILITY CARE - The school gym area used by your group must be left clean and orderly with school furniture and property returned to its designated place. Garbage and trash must be bagged and disposed of in the dumpster location. 3. KITCHEN RULES (will be sent separately if use of kitchen is requested). 4. NO SMOKING AND NO ALCOHOL USE ALLOWED. 5. BUILDING USE - All groups agree that they will ensure that all event participants leave the building after the event. 6. RESERVATION TIME - The reserved room/space may not be used before or after the approved timeslot – even if there are no other reservations before or after your reserved time. Only reserved rooms may be used the day of reservation. 7. SUPERVISION OF CHILDREN AND YOUTH - Safe environment guidelines for children and youth apply. Adult supervision is required at all times both inside and outside of the church property including the parking lot. Children and/or siblings of group members must stay with the group or under the care of additional adult supervisors. Please verify that at least two adults will be there. 8. FOOD AND DRINK - Food and drink should be limited to designated areas. Please do not have food or drink in hallways or outside. 9. DECORATIONS - Decorations may not be attached to the walls or doors with tape or anything that will damage the surface. All decorations must be removed immediately and completely following the event. 10. BREAKAGE - All persons and/or groups using our facilities are expected to exercise reasonable care and judgment to prevent defacement, damage or breakage. The requester of facility use shall be responsible for paying costs incurred by the school in cleaning, repairing, or otherwise refurbishing any part of the building and/or its furnishings and equipment which, in the judgment of the Building and Grounds Committee, has been carelessly or irresponsibly subjected to more than normal wear and tear by the person(s) or group(s) involved. 11. SAFETY – For the safety and security, St Mary's prohibits certain items from being brought into the school: guns & firearms, martial arts & self defense items • bows & arrows, explosive & flammable materials, disabling chemicals & other dangerous items. (Hardcopy will also be required) (*)
YES NO Invalid Input
I understand that if my requested is approved, I will receive an email confirmation (unless pre-approved). (*)
YES NO Invalid Input
Please note that some web based email addresses (hotmail.com, live.com, msn.com & outlook.com, yahoo.com, aol.com) are currently not receiving automated emails. Add our domain @stmarysschoolbellevue.com to your settings to improve receipt, or use an alternate email address. Our apologies for the inconvenience.
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